pistas de una enfermedad organica subyacente en el sindrome de brugada

n/

C-Reactive Protein Levels in the Brugada Syndrome

Background. Inflammation in the Brugada syndrome (BrS) and its clinical implication have been little studied. Aims. To assess the level of inflammation in BrS patients. Methods. All studied BrS patients underwent blood samples drawn for C-reactive protein (CRP) levels at admission, prior to any invasive intervention. Patients with a previous ICD placement were controlled to exclude those with a recent (<14 days) shock. We divided subjects into symptomatic (syncope or aborted sudden death) and asymptomatic groups. In a multivariable analysis, we adjusted for significant variables (age, CRP ≥ 2 mg/L). Results. Fifty-four subjects were studied (mean age 45 ± 13 years, 49 (91%) male). Twenty (37%) were symptomatic. Baseline characteristics were similar in both groups. Mean CRP level was 1,4 ± 0,9 mg/L in asymptomatic and 2,4 ± 1,4 mg/L in symptomatic groups (P = .003). In the multivariate model, CRP concentrations ≥ 2 mg/L remained an independent marker for being symptomatic (P = .018; 95% CI: 1.3 to 19.3). Conclusion. Inflammation seems to be more active in symptomatic BrS. C-reactive protein concentrations ≥ 2 mg/L might be associated with the previous symptoms in BrS. The value of inflammation as a risk factor of arrhythmic events in BrS needs to be studied

Relación del intervalo QT corregido con la escala GRACE en pacientes con infarto de miocardio sin elevación del segmento ST

Background. The Global Registry of Acute Coronary Events (GRACE) prediction model stratifies patients with non-ST-segment elevation myocardial infarction (NSTEMI). Corrected QT interval (QTc) is not considered in this model. Objective. To evaluate the relationship between the QTc interval and the GRACE score in patients with NSTEMI. Materials and methods. An observational, retrospective study was carried between 2016 and 2019. We included patients with diagnosis of NSTEMI, QTc intervals were calculated with Bazett’s formula, and they were classified into 2 groups: a normal QTc interval (&lt;440 ms) and prolonged (≥440 ms). According to the GRACE score they were classified in three ranges: low risk (≤109 points), intermedium (110 - 139 points) and high (≥140 points), we determined if there were a correlation between QTc interval and the GRACE score. Results. A total of 940 patients with a diagnosis of NSTEMI were admitted in our institution, 634 met the inclusion criteria, there were 390 patients with normal QTc interval and 244 with a prolonged QTc interval. Patients with prolonged QTc were older (65.5 vs 61, p=0.001) with a lower proportion of males (71.7% vs 82.8%, p=0.001). An association was found between the GRACE score and the QTC interval, subjects with a normal QTc had a greater proportion of low and intermediate risk than those with a prolonged QTc (p=0.001). Conclusions. In NSTEMI patients, a normal QTc interval (&lt;440 ms) is associated with a GRACE risk score of low or intermediate risk.Antecedentes. El modelo de predicción del registro global de eventos coronarios agudos (GRACE por sus siglas en inglés) es usado para estratificar el riesgo en pacientes con infarto de miocardio sin elevación del segmento ST (IAMSEST). El intervalo QT corregido (QTc) no se considera en este modelo. Objetivo. Evaluar la relación entre el intervalo QTc con la escala GRACE en pacientes con IAMSEST. Materiales y métodos. Se realizó un estudio observacional retrospectivo entre 2016 y 2019. Se incluyeron pacientes con diagnóstico de IAMSEST, los intervalos QTc se calcularon con la fórmula de Bazett y se clasificaron en dos grupos: intervalo QTc normal (&lt;440 ms) y prolongado (≥440 ms). Según el puntaje GRACE fueron clasificados en tres rangos: riesgo bajo (≤109 puntos), intermedio (110-139 puntos) y alto (≥140 puntos), se determinó si existía relación entre el intervalo QTc y la puntuación GRACE. Resultados. Durante el período mencionado ingresaron en nuestro centro 940 pacientes con diagnóstico de IAMSEST, 634 cumplieron con los criterios de inclusión; hubo 390 pacientes con intervalo QTc normal y 244 con intervalo QTc prolongado. Los pacientes con QTc prolongado eran mayores (65,5 vs. 61, p=0,001) con menor proporción de hombres (71,7% vs. 82,8%, p=0,001). Se encontró asociación entre la escala GRACE y el intervalo QTC, los sujetos con un QTc normal tenían una mayor proporción de riesgo bajo e intermedio que aquellos con un QTc prolongado (p=0,001). Conclusiones. En pacientes con IAMSEST un intervalo QTc normal (&lt;440 ms) se relaciona con una escala de riesgo GRACE de riesgo bajo o intermedio

Acute and long-term success of ventricular tachycardia ablation in patients with ischemic heart disease in a Mexican center

Objective. To report the results of ventricular tachycardia (VT) catheter ablation in ischemic heart disease (IHD), and to identify risk factors associated with recurrence in a Mexican center. Materials and methods. We made a retrospective review of the cases of VT ablation performed in our center from 2015 to 2022. We analyzed the characteristics of the patients and those of the procedures separately and we determined factors associated with recurrence. Results. Fifty procedures were performed in 38 patients (84% male; mean age 58.1 years). Acute success rate was 82%, with a 28% of recurrences. Female sex (OR 3.33, IC 95% 1.66–6.68, p=0.006), atrial fibrillation (OR 3.5, IC 95% 2.08–5.9, p=0.012), electrical storm (OR 2.4, IC 95% 1.06–5.41, p=0.045), functional class greater than II (OR 2.86, IC 95% 1.34–6.10, p=0.018) were risk factors for recurrence and the presence of clinical VT at the time of ablation (OR0.29, IC95% 0.12–0.70, p=0.004) and the use of more than 2 techniques for mapping (OR 0.64, IC 95% 0.48–0.86, p=0.013) were protective factors. Conclusions. Ablation of ventricular tachycardia in ischemic heart disease has had good results in our center. The recurrence is similar to that reported by other authors and there are some factors associated with it.Objective. To report the results of ventricular tachycardia (VT) catheter ablation in ischemic heart disease (IHD), and to identify risk factors associated with recurrence in a Mexican center. Materials and methods. We made a retrospective review of the cases of VT ablation performed in our center from 2015 to 2022. We analyzed the characteristics of the patients and those of the procedures separately and we determined factors associated with recurrence. Results. Fifty procedures were performed in 38 patients (84% male; mean age 58.1 years). Acute success rate was 82%, with a 28% of recurrences. Female sex (OR 3.33, IC 95% 1.66–6.68, p=0.006), atrial fibrillation (OR 3.5, IC 95% 2.08–5.9, p=0.012), electrical storm (OR 2.4, IC 95% 1.06–5.41, p=0.045), functional class greater than II (OR 2.86, IC 95% 1.34–6.10, p=0.018) were risk factors for recurrence and the presence of clinical VT at the time of ablation (OR0.29, IC95% 0.12–0.70, p=0.004) and the use of more than 2 techniques for mapping (OR 0.64, IC 95% 0.48–0.86, p=0.013) were protective factors. Conclusions. Ablation of ventricular tachycardia in ischemic heart disease has had good results in our center. The recurrence is similar to that reported by other authors and there are some factors associated with it

Case report: Challenges and implications of conduction system pacing in pediatrics: Case series

Cardiac electrical stimulation in children usually is needed in the setting of complete congenital atrioventricular block, atrioventricular block after heart surgery, and bradycardia associated with some specific channelopathies. In cases of atrioventricular block, the high percentage of ventricular stimulation raises concern on the deleterious effects of chronic stimulation of the right ventricle. In recent years, physiologic stimulation has developed as a valid approach for adult patients and a great interest has risen in offering conduction system pacing also to the pediatric population. We present three pediatric cases of stimulation of the conduction system (His bundle or left bundle branch), in order to show the intrinsic particularities and challenges implied in these new techniques

A machine learning approach to personalized predictors of dyslipidemia: a cohort study

IntroductionMexico ranks second in the global prevalence of obesity in the adult population, which increases the probability of developing dyslipidemia. Dyslipidemia is closely related to cardiovascular diseases, which are the leading cause of death in the country. Therefore, developing tools that facilitate the prediction of dyslipidemias is essential for prevention and early treatment.MethodsIn this study, we utilized a dataset from a Mexico City cohort consisting of 2,621 participants, men and women aged between 20 and 50 years, with and without some type of dyslipidemia. Our primary objective was to identify potential factors associated with different types of dyslipidemia in both men and women. Machine learning algorithms were employed to achieve this goal. To facilitate feature selection, we applied the Variable Importance Measures (VIM) of Random Forest (RF), XGBoost, and Gradient Boosting Machine (GBM). Additionally, to address class imbalance, we employed Synthetic Minority Over-sampling Technique (SMOTE) for dataset resampling. The dataset encompassed anthropometric measurements, biochemical tests, dietary intake, family health history, and other health parameters, including smoking habits, alcohol consumption, quality of sleep, and physical activity.ResultsOur results revealed that the VIM algorithm of RF yielded the most optimal subset of attributes, closely followed by GBM, achieving a balanced accuracy of up to 80%. The selection of the best subset of attributes was based on the comparative performance of classifiers, evaluated through balanced accuracy, sensitivity, and specificity metrics.DiscussionThe top five features contributing to an increased risk of various types of dyslipidemia were identified through the machine learning technique. These features include body mass index, elevated uric acid levels, age, sleep disorders, and anxiety. The findings of this study shed light on significant factors that play a role in dyslipidemia development, aiding in the early identification, prevention, and treatment of this condition

Out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation in patients with normal electrocardiograms:results from a multicentre long-term registry

AIMS : To define the clinical characteristics and long-term clinical outcomes of a large cohort of patients with idiopathic ventricular fibrillation (IVF) and normal 12-lead electrocardiograms (ECGs). METHODS AND RESULTS: Patients with ventricular fibrillation as the presenting rhythm, normal baseline, and follow-up ECGs with no signs of cardiac channelopathy including early repolarization or atrioventricular conduction abnormalities, and without structural heart disease were included in a registry. A total of 245 patients (median age: 38 years; males 59%) were recruited from 25 centres. An implantable cardioverter-defibrillator (ICD) was implanted in 226 patients (92%), while 18 patients (8%) were treated with drug therapy only. Over a median follow-up of 63 months (interquartile range: 25-110 months), 12 patients died (5%); in four of them (1.6%) the lethal event was of cardiac origin. Patients treated with antiarrhythmic drugs only had a higher rate of cardiovascular death compared to patients who received an ICD (16% vs. 0.4%, P = 0.001). Fifty-two patients (21%) experienced an arrhythmic recurrence. Age ≤16 years at the time of the first ventricular arrhythmia was the only predictor of arrhythmic recurrence on multivariable analysis [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.18-0.92; P = 0.03]. CONCLUSION : Patients with IVF and persistently normal ECGs frequently have arrhythmic recurrences, but a good prognosis when treated with an ICD. Children are a category of IVF patients at higher risk of arrhythmic recurrences

Programa de ablación con catéter de la fibrilación auricular en el Instituto Nacional de Cardiología "Ignacio Chávez "

Se describen los procedimientos que se realizan antes, durante y después de la ablación con catéter de la fibrilación auricular (FA) como parte del programa de ablación con catéter de la FA establecido por la Clínica de Fibrilación Auricular en el Instituto Nacional de Cardiología "Ignacio Chávez". Actualmente se cuentan con criterios de selección para ablación con catéter de la FA, siendo éstos diferentes para los casos de FA paroxística/persistente y aquéllos con FA crónica. Los estudios preoperatorios incluyen una imagen por resonancia magnética o una tomografía computada de aurícula izquierda y venas pulmonares. La técnica de la ablación de la FA paroxística/persistente es el aislamiento circunferencial o segmentario de cada vena pulmonar. Para la FA crónica se prefiere el aislamiento grupal de las venas pulmonares derechas seguida del aislamiento de las izquierdas (el orden puede invertirse) mediante el empleo del mapeo electroanatómico tridimensional. El seguimiento postoperatorio inmediato incluye visitas y estudios de gabinete (ECG, monitoreo Holter de 24 horas) al mes y a los 3, 6 y 12 meses. La ablación con catéter de la FA es un procedimiento intervencionista complejo que se debe estandarizar en sus aspectos pre, trans y postoperatorios